CANCER RELATED FATIGUE: Nearly everyone struggles with being overtired or overworked from time to time. Such instances are temporary, and usually have an identifiable cause and a likely remedy. Chronic fatigue related to cancer, on the other hand, lasts longer and is more profound. It's a nearly constant state of weariness that develops over time and diminishes your energy and mental capacity. Fatigue at this level impacts your emotional and psychological well-being, too.
Fatigue isn't the same thing as sleepiness, although it's often accompanied by a desire to sleep — and a lack of motivation to do anything else.
Acute fatigue: lasts less than a month
Chronic fatigue: lasts over a month
Cancer-related fatigue
one of cancer treatment’s most common side effects
sudden onset
cannot be resolved by sleep
may not end after treatment
idiopathic, though any and all cancer treatments may be at fault (surgery, chemo, radiation)
often said to be paralyzing
may last a few days, up to a year, post treatment
Psychological issues: Contributing factors to Cancer Related Fatigue:
anxiety
grief
stress
depression
Medication/Treatment:
Vincristine, vinblastine, and cisplatin, are chemo drugs that often cause CRF, though any chemo medications may cause fatigue.
Cumulative fatigue is fatigue that builds up over time, and can be a result of radiation therapy.
Bone marrow transplant is very aggressive, and the CRF can last up to one year.
Biologic therapy refers to white blood cells releasing cytokines in response to infection. Cytokines bring messages, regulating elements in other parts of the immune and endocrine systems, which in large numbers are toxic, leading to constant fatigue.
Insomnia, depression, stress, Pain, hypothyroidism, decreased nutrition, tumor-induced hyper-metabolic state, combination therapy, or anemia can contribute to cancer related fatigue.
Medications used to treat side effects such as nausea, pain, depression, anxiety, and seizures can contribute to CRF.
Nursing Interventions:
Recognize signs and symptoms:
boredom
unmotivated
inability to concentrate
decreased energy
sleepiness
weakness
malaise, whole body tiredness
irritable
Then, treat the underlying cause. Tips to combat fatigue: recognize symptoms and reduce activity when they appear; conserve energy; good nutrition (consult dietician, take multivitamin); exercise consistently but in moderation; use proper body mechanics; limit visitors; take short afternoon naps; avoid extremes in temperature; and, use diversion for stress management. The following information is directly from the Cleveland Clinic Article: “Nutrition to combat cancer fatigue: CRF is often made worse if you are not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more overall energy. The following are strategies to help improve nutritional intake. Basic calorie needs:
Estimated calorie needs for person with cancer is 15 calories per pound of weight if your weight has been stable. Add 500 calories per day if you have lost weight.
Example: A person who weighs 150 lbs. needs about 2,250 calories per day to maintain weight.
Protein rebuilds and repairs damaged (and normally aging) body tissue:
Estimated protein needs are 0.5 - 0.6 grams of protein per pound of body weight.
Example: A 150 lb. person needs 75-90 grams of protein per day.
The best sources of protein include foods from the dairy group (8 oz. milk = 8 grams protein) and meats (meat, fish, or poultry = 7 grams of protein per ounce).
Fluid needs:
A minimum of 8 cups of fluid per day will prevent dehydration. (That is 64 ounces, 2 quarts, or 1 half-gallon.)
Fluids can include juice, milk, broth, milkshakes, Jello®, and other beverages. Of course, water is fine, too.
Beverages containing caffeine do NOT count.
Fluid losses from excess vomiting or diarrhea will require extra fluids.”
Patient Teaching: Per Mayo Clinic, “Cancer-related fatigue is different from the fatigue of everyday life, which is usually temporary and often relieved by a good night's sleep. Cancer-related fatigue is an overwhelming sense of exhaustion and persistent feeling of tiredness that can accompany cancer and cancer treatment. It's usually not relieved by rest or sleep.” Here are some strategies to help with cancer-related fatigue:
Allow time earlier in the day for short periods of rest, so that night sleep is not disturbed.
Talk with your doctor or nurse about a program of regular exercise. Mild to moderate exercise has been found to be helpful in reducing fatigue. Consider swimming, walking, yoga, etc.
Balance rest, sleep, and activity. While sleep and rest are important, don't overdo it. Too much rest can actually decrease your energy level.
Eat a well-balanced diet and drink plenty of liquids. Your body needs protein, carbohydrates, vitamins, minerals, and water to work efficiently. Meet with a nutritionist or dietitian to find the best plan for you.
Don't be afraid to ask for help, it makes others feel needed and helps you get things done. For example, neighbors may pick up items for you at the grocery store while doing their own shopping.
Use relaxation methods or creative outlets to reduce stress (i.e. deep breathing, imagery, meditation, music, art).
Maintain your social life. Many people eliminate social activities all together when they are feeling fatigued. Include activities that are satisfying to you in order to replenish your spirit. These activities can actually add to your energy level.
Work with your health care provider to keep symptoms like anemia, nausea, and fever under control.
Schedule a doctor's visit Call for an appointment with your doctor if your fatigue has persisted for two or more weeks despite making an effort to rest, reduce stress, eat right and drink plenty of fluids. Seek immediate medical attention Get someone to take you to an emergency room or urgent care if fatigue is accompanied by:
Abnormal bleeding, including bleeding from your rectum or vomiting blood
Unexplained weight loss or gain
Severe abdominal, pelvic or back pain
Severe headache
Call 911 or your local emergency medical service Get emergency help if your fatigue is related to a mental health problem and your symptoms also include:
Thoughts of harming yourself or of suicide
Concern that you may harm someone else
Also get emergency care if your fatigue is accompanied by any of the following:
Nearly everyone struggles with being overtired or overworked from time to time. Such instances are temporary, and usually have an identifiable cause and a likely remedy.
Chronic fatigue related to cancer, on the other hand, lasts longer and is more profound. It's a nearly constant state of weariness that develops over time and diminishes your energy and mental capacity. Fatigue at this level impacts your emotional and psychological well-being, too.
- Fatigue isn't the same thing as sleepiness, although it's often accompanied by a desire to sleep — and a lack of motivation to do anything else.
- Acute fatigue: lasts less than a month
- Chronic fatigue: lasts over a month
Cancer-related fatigue- one of cancer treatment’s most common side effects
- sudden onset
- cannot be resolved by sleep
- may not end after treatment
- idiopathic, though any and all cancer treatments may be at fault (surgery, chemo, radiation)
- often said to be paralyzing
- may last a few days, up to a year, post treatment
Psychological issues:Contributing factors to Cancer Related Fatigue:
- anxiety
- grief
- stress
- depression
Medication/Treatment:- Vincristine, vinblastine, and cisplatin, are chemo drugs that often cause CRF, though any chemo medications may cause fatigue.
- Cumulative fatigue is fatigue that builds up over time, and can be a result of radiation therapy.
- Bone marrow transplant is very aggressive, and the CRF can last up to one year.
- Biologic therapy refers to white blood cells releasing cytokines in response to infection. Cytokines bring messages, regulating elements in other parts of the immune and endocrine systems, which in large numbers are toxic, leading to constant fatigue.
- Insomnia, depression, stress, Pain, hypothyroidism, decreased nutrition, tumor-induced hyper-metabolic state, combination therapy, or anemia can contribute to cancer related fatigue.
- Medications used to treat side effects such as nausea, pain, depression, anxiety, and seizures can contribute to CRF.
Nursing Interventions:- Recognize signs and symptoms:
- boredom
- unmotivated
- inability to concentrate
- decreased energy
- sleepiness
- weakness
- malaise, whole body tiredness
- irritable
Then, treat the underlying cause.Tips to combat fatigue: recognize symptoms and reduce activity when they appear; conserve energy; good nutrition (consult dietician, take multivitamin); exercise consistently but in moderation; use proper body mechanics; limit visitors; take short afternoon naps; avoid extremes in temperature; and, use diversion for stress management.
The following information is directly from the Cleveland Clinic Article:
“Nutrition to combat cancer fatigue:
CRF is often made worse if you are not eating enough or if you are not eating the right foods. Maintaining good nutrition can help you feel better and have more overall energy. The following are strategies to help improve nutritional intake.
Basic calorie needs:
- Estimated calorie needs for person with cancer is 15 calories per pound of weight if your weight has been stable. Add 500 calories per day if you have lost weight.
- Example: A person who weighs 150 lbs. needs about 2,250 calories per day to maintain weight.
Protein rebuilds and repairs damaged (and normally aging) body tissue:- Estimated protein needs are 0.5 - 0.6 grams of protein per pound of body weight.
- Example: A 150 lb. person needs 75-90 grams of protein per day.
- The best sources of protein include foods from the dairy group (8 oz. milk = 8 grams protein) and meats (meat, fish, or poultry = 7 grams of protein per ounce).
Fluid needs:- A minimum of 8 cups of fluid per day will prevent dehydration. (That is 64 ounces, 2 quarts, or 1 half-gallon.)
- Fluids can include juice, milk, broth, milkshakes, Jello®, and other beverages. Of course, water is fine, too.
- Beverages containing caffeine do NOT count.
- Fluid losses from excess vomiting or diarrhea will require extra fluids.”
Patient Teaching:Per Mayo Clinic,
“Cancer-related fatigue is different from the fatigue of everyday life, which is usually temporary and often relieved by a good night's sleep. Cancer-related fatigue is an overwhelming sense of exhaustion and persistent feeling of tiredness that can accompany cancer and cancer treatment. It's usually not relieved by rest or sleep.”
Here are some strategies to help with cancer-related fatigue:
- Allow time earlier in the day for short periods of rest, so that night sleep is not disturbed.
- Talk with your doctor or nurse about a program of regular exercise. Mild to moderate exercise has been found to be helpful in reducing fatigue. Consider swimming, walking, yoga, etc.
- Balance rest, sleep, and activity. While sleep and rest are important, don't overdo it. Too much rest can actually decrease your energy level.
- Eat a well-balanced diet and drink plenty of liquids. Your body needs protein, carbohydrates, vitamins, minerals, and water to work efficiently. Meet with a nutritionist or dietitian to find the best plan for you.
- Don't be afraid to ask for help, it makes others feel needed and helps you get things done. For example, neighbors may pick up items for you at the grocery store while doing their own shopping.
- Use relaxation methods or creative outlets to reduce stress (i.e. deep breathing, imagery, meditation, music, art).
- Maintain your social life. Many people eliminate social activities all together when they are feeling fatigued. Include activities that are satisfying to you in order to replenish your spirit. These activities can actually add to your energy level.
- Work with your health care provider to keep symptoms like anemia, nausea, and fever under control.
Schedule a doctor's visitCall for an appointment with your doctor if your fatigue has persisted for two or more weeks despite making an effort to rest, reduce stress, eat right and drink plenty of fluids.
Seek immediate medical attention
Get someone to take you to an emergency room or urgent care if fatigue is accompanied by:
- Abnormal bleeding, including bleeding from your rectum or vomiting blood
- Unexplained weight loss or gain
- Severe abdominal, pelvic or back pain
- Severe headache
Call 911 or your local emergency medical serviceGet emergency help if your fatigue is related to a mental health problem and your symptoms also include:
- Thoughts of harming yourself or of suicide
- Concern that you may harm someone else
Also get emergency care if your fatigue is accompanied by any of the following:- Chest pain
- Shortness of breath
- Irregular or fast heartbeat
- Feeling that you might pass out
Although fatigue can sometimes be difficult to cope with, it can be managed.REFERENCES
Medical-surgical nursing: patient-centered collaborative care/ [edited by] Donna D. Ignatavicius, M. Linda Workman. – 6th ed.
Websites
http://www.emedicinehealth.com/slideshow_pictures_causes_of_fatigue/article_em.htm
http://my.clevelandclinic.org/disorders/cancer/hic_cancer-related_fatigue.aspx
http://www.mayoclinic.com/health/cancer-related-fatigue/MY01198
Journal Article
Journal of General Internal Medicine; Nov2009 Supplement 2, Vol. 24, p412-416, 5p, 2 Charts
By: Aneesa Jessani & Julie Jones